Life-course management of gestational diabetes mellitus: A narrative review

Figure 3 Stepwise clinical algorithm for the diagnosis and management of gestational diabetes mellitus. This flowchart outlines a standardized care pathway from initial screening—via oral glucose tolerance testing (OGTT) at 24-28 weeks—to postpartum follow-up. Lifestyle intervention constitutes the cornerstone of treatment, while pharmacologic therapy (primarily insulin, with metformin as an alternative) is initiated if glycemic targets are not met within 10-14 days. Postpartum OGTT and ongoing metabolic surveillance are essential to mitigate future risks of type 2 diabetes mellitus and cardiovascular disease. Blue blocks: Diagnostic and monitoring checkpoints (e.g., OGTT at 24-28 weeks, 10-14 days reassessment). Gray-blue blocks: Lifestyle and non-pharmacologic interventions (e.g., medical nutrition therapy, exercise, and glycemic control). Orange blocks: Persistent hyperglycemia (e.g., glycemia uncontrolled). Yellow blocks: Pharmacologic therapy and delivery planning (e.g., insulin initiation, intrapartum glucose targets). Pale-pink blocks: Intrapartum management and delivery timing considerations. Pale-gray blocks: Postpartum surveillance (e.g., OGTT at 6-12 weeks, annual screening every 1-3 years). GDM: Gestational diabetes mellitus; OGTT: Oral glucose tolerance test.